Study identifies challenges faced by NYU nurses after Hurricane Sandy

Many recall the dramatic images of nurses at New York University's Langone Medical Center (NYULMC) heroically evacuating over three hundred patients, carrying many including the youngest and most vulnerable down flights of stairs during the power outage resulting from the storm surge generated by Hurricane Sandy.

Now, a recent study by researchers at the New York University Colleges of Nursing (NYUCN) and of Dentistry (NYUCD), published in The Journal of Urban Health examines the impact on NYULMC nurses' post-Sandy deployment to help address patient surge in eight local hospitals and health facilities that had not been as affected by the storm.

The mixed method study, "Challenges of Nurses' Deployment to Other New York City Hospitals in the Aftermath of Hurricane Sandy," is one of only a few to evaluate the psychological toll on nurses working in such rapidly changing, uncontrolled, and potentially dangerous circumstances. The researchers conducted in-depth qualitative interviews with a sample of 16 nurses, reflecting the diversity of practice areas, nursing experience, and organizational role in the disaster. Subsequently, 528 NYULMC nurses completed an on-line quantitative survey about their Hurricane Sandy experiences. The study identified multiple challenges associated with the post-evacuation deployment to other area hospitals.

"We found that more than half of the deployed nurses surveyed (54%) characterized their deployment as extremely or very stressful, and many of these nurses remained on these interim assignments for up to two months," said lead author Nancy Van Devanter, DrPH, RN, EdM, FAAN, an associate professor at NYUCN specializing in health services research.

The qualitative interviews revealed several psychosocial and practice-based challenges including: working in an unfamiliar environment; limited orientation time; legal concerns; and issues related to assignments. Only 30% of nurses surveyed thought they received a "sufficient" orientation to the host hospital. Further complicating matters, several nurses described situations where they were assigned to more patients than they felt they could safely care for.

"We saw that the immediacy of the natural disaster limited opportunities for host hospitals to provide deployed nurses with a comprehensive orientation," said Christine T. Kovner, PhD, RN, FAAN, study co-author and NYUCN professor. "This caused the nurses a great deal of stress and concern over a lack of familiarity with the host hospital's documentation systems, equipment, policies, and procedures."

While the separation from their co-workers was also a significant stressor for the nurses, the researchers noted that the nurses made specific efforts to keep in touch during the deployment period. One participant elaborated on the extent of their communication during that time saying, "I talked to my coworkers on the phone more in those three months than I talked to them on the phone in almost five years that I've worked here."

"Another aim of our research was to identify resources that helped nurses deal with their stress during the ordeal," said co-author Victoria H. Raveis, MA, MPhil, PhD, research professor and director, Psychosocial Research Unit on Health, Aging and the Community at NYUCD. "The study showed that peer support served as a major mode of stress reduction. Almost every participant in the qualitative study touched upon the importance of the support their NYULMC peers provided in adjusting to the deployment experience."

The researchers also found that support from NYULMC supervisors helped alleviate the deployed nurses' stress. Because nurse managers had no formal role once their nurses were deployed, they developed creative advocacy and communication strategies to provide needed support for their staff.

The researchers' findings will be used to inform policies that facilitate in future disaster response supporting skilled nurses' participation in deployment in a more effective and meaningful way.

"Our findings will allow us to advocate for the establishment of formal structures to enhance opportunities for nurses deployed during disasters to interact and work with some of their peers, especially when it is not possible to deploy intact teams to host hospitals," said Van Devanter.

The authors of this study cite the need for further research to identify challenges experienced by nurses from the host hospitals and from the other hospitals that were evacuated as a result of Hurricane Sandy, adding that such research could further inform regional and national planning, procedure, and policy development to facilitate deployment and address patient surge for future disasters.